alvimopan

Therapeutic Classification: gastric stimulant

Pharmacologic Classification: opioid antagonists

Indications ⬆ ⬇

REMS

Speed time to upper/lower GI recovery following partial bowel resection surgery with primary anastomosis.

Action ⬆ ⬇

Acts peripherally as μ-opioid receptor antagonist, which speeds recovery of bowel function after to partial large or small bowel resection surgery with anastomosis surgery.

Therapeutic effects:

Accelerated time to bowel recovery following primary anastomotic surgery.

Pharmacokinetics ⬆ ⬇

Absorption: 6% absorbed following oral administration.

Distribution: Does not cross the blood-brain barrier.

Protein Binding: alvimopan: 80% bound to albumin; metabolite: 94% bound to albumin.

Metabolism/Excretion: Converted by bacterial flora in the GI tract to an active metabolite; elimination is mostly via biliary secretion, followed by conversion by bacterial flora. Elimination of unabsorbed drug and metabolites is via feces and urine.

Half-Life: alvimopan: 10–17 hr; metabolite: 10–18 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Therapeutic doses of opioid analgesics for more than 7 consecutive days before initiation of alvimopan;
Severe hepatic impairment or end-stage renal disease;
Complete gastrointestinal obstruction;
Pancreatic or gastric anastomoses.

Use Cautiously in:

More than 3 doses of opioids within the wk prior to surgery (↑ sensitivity to effects and adverse reactions, including abdominal pain, nausea, vomiting, and diarrhea);
Mild to moderate hepatic or renal impairment (↑ risk of adverse reactions);
Japanese patients (may have ↑ risk of adverse reactions);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: MI

F and E: hypokalemia

GI: constipation, dyspepsia, flatulence

GU: urinary retention

Hemat: anemia

MS: back pain

Interactions ⬆ ⬇

Drug-drug:

Previous (within 1 wk) opioid use ↑ risk of adverse reactions (avoid if therapeutic opioid doses used during prior wk; use cautiously if more than 3 doses have been used).

Route/Dosage ⬆ ⬇

PO (Adults ): 12 mg for 30 min–5 hr prior to surgery; then 12 mg twice daily until discharge for a maximum of 7 days (up to 15 doses).

Availability ⬆ ⬇

(Generic available)

Capsules: 12 mg

Assessment ⬆ ⬇

Assess bowel sounds and frequency, quantity, and consistency of stools periodically during therapy.

Lab Test Considerations:

May cause anemia and hypokalemia.

Implementation ⬆ ⬇

REMS: Because of potential risk of MI associated with long-term use, must be administered only during hospitalization for short-term use. Only available in hospitals enrolled in the Alvimopan REMS Program
.
PO: Administer twice daily without regard to food for no more than 7 days.

Patient/Family Teaching ⬆ ⬇

Explain purpose of alvimopan to patient and that it is only to be used during hospitalization.
Advise patient to notify health care professional if they have taken long-term or intermittent opioid pain therapy, including any use of opioids in the wk prior to receiving alvimopan.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇